Chapter 36. Atrial Fibrillation: Upstream Therapies

  1. Salim Yusuf DPhil, FRCPC, FRSC Research Chair Professor of Medicine Director Vice President Research1,2,3,
  2. John A Cairns MD, FRCPC Professor of Medicine Former Dean4,
  3. A John Camm MD British Heart Foundation Professor Head of Cardiac5,
  4. Ernest L Fallen MD, FRCPC Professor Emeritus6 and
  5. Bernard J Gersh MB, ChB, DPhil Consultant Professor of Medicine7
  1. Antonios Kourliouros MD,
  2. Irina Savelieva MD,
  3. Marjan Jahangiri FRCS Professor of Cardiac Surgery and
  4. A John Camm MD British Heart Foundation Professor Head of Cardiac

Published Online: 21 MAY 2010

DOI: 10.1002/9781444309768.ch36

Evidence-Based Cardiology, Third Edition

Evidence-Based Cardiology, Third Edition

How to Cite

Kourliouros, A., Savelieva, I., Jahangiri, M. and Camm, A. J. (2009) Atrial Fibrillation: Upstream Therapies, in Evidence-Based Cardiology, Third Edition (eds S. Yusuf, J. A. Cairns, A. J. Camm, E. L. Fallen and B. J. Gersh), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444309768.ch36

Editor Information

  1. 1

    McMaster University, Canada

  2. 2

    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Canada

  3. 3

    Hamilton Health Sciences, Hamilton, Ontario, Canada

  4. 4

    Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

  5. 5

    St George's University of London, London, UK

  6. 6

    McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

  7. 7

    Mayo Clinic College of Medicine, Rochester, MN, USA

Author Information

  1. St George's University of London, London, UK

Publication History

  1. Published Online: 21 MAY 2010
  2. Published Print: 13 NOV 2009

ISBN Information

Print ISBN: 9781405159258

Online ISBN: 9781444309768



  • atrial fibrillation;
  • upstream therapies;
  • angiotensin-converting enzyme inhibitors;
  • angiotensin receptor blockers;
  • statins;
  • n-3 polyunsaturated fatty acids;
  • corticosteroids


Atrial fibrillation (AF) is a leading cause of thromboembolism and cardiac morbidity. Antiarrhythmic drugs still form the mainstay of pharmacological therapy for AF, but do not offer definitive treatment despite their proven efficacy in symptom control and prevention of haemodynamic complications. Upstream management of AF refers to agents that target the responsible substrate and either prevent the initiation of the arrhythmia or delay its occurrence and domestication. Experimental and clinical data suggest the potentially protective effect of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, n-3 polyunsaturated fatty acids and corticosteroids. The efficacy of these upstream therapies in AF prevention is systematically evaluated against the background of variable cardiovascular pathologies and different therapeutic interventions.